Certification Acknowledgement Form

Your Name*
Company Name*
Choose Certification*
United States Business Registration Inc
(888) 646-9998 Toll-Free
(888) 255-4963 Fax
info@usbri.us

1310 Heather Ridge Blvd
Dunedin, FL 34698
www.usbri.us

Small Business Certification
Qualification Interview
Acknowledgement & Agreement

As a primary officer/owner/authorized legal representative of the Legal Entity mentioned above, I confirm that I have completed the qualification interview with a CRS (Certified Registration Specialist) for said Small Business Certification chosen above. All information provided to the CRS whether oral or in writing was truthful and accurate as of the date of the interview. I understand that I meet the qualifications for applying for the Certification chosen above.

I have access to all the pertinent documents mentioned within the qualification interview required to apply for the stated certification. I meet the Small Business Administration's size standards for the applicable NAICS codes, as gone over within the interview. My business organization is properly structured and legally registered within the state I operate within.

I fully understand that if any documents that are submitted to either USBRI or the Small Business Administration contradict the information provided to the CRS within the qualification interview, may result in the denial or delay of my Certification application. If this occurs USBRI, it's officers, contractors, employees, etc. cannot be held responsible for the denial of the application for the certification submitted. If this occurs, the Director of Certifications will look at your certification submission for any possibilities of appealing and resubmitting for approval. No more than a total of 3 application submissions within a 12 month period for the same legal entity. I also understand that the processing fee collected by USBRI will be non-refundable regardless of application status.
*
- As an officer, director, owner, legal representative or authorized representative of the organization mentioned at the top of this document, I attest that all information provided is true and correct to the best of my knowledge.
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Certification Acknowledgement Form

Certification Acknowledgement Form

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